Cranial fixation apparatus



July 9, 1968 G GEORGIADE ET AL 3,391,693

CRANIAL FIXAT ION APPARATUS Filed Feb. 11, 1966 INVENTORS Nicholas G.Georgiackz Thomas H. Nash, Jr.

AT TORNEY United States Patent 3,391,693 CRANIAL FIXATION APPARATUSNicholas G. Georgiade, 2527 Wrightwood Ave., Durham, NC. 27705, andThomas H. Nash, In, Durham, N.C.; said Nash assignor to said GeorgiadeFiled Feb. 11, 1966, Ser. No. 526,891 8 Claims. (Cl. 128-87) Thisinvention relates to a head apparatus useful in treating fracturedfacial bones and, more particularly, to a maxillofacial fixationapparatus which is positioned on the cranium and which is adapted toimmobilize fractured facial bones during the knitting thereof.

In the fixation of fractured maxillae and other facial bones, the priorart teaches the use of plaster head caps which form a base of fixationto which various wires, rods and the like may be attached in order tosupply traction to the broken bones. A considerable amount of time andenergy is consumed in applying the plaster head cap to the patient;also, the plaster head cap is uncomfortable and is not particularlyadapted to aid in the fixation of all maxillofacial fractures. The priorart also shows other traction fixation apparatus which are strapped onthe skull or are provided with pins which anchor in the skull.Appliances of this type have one characteristic disadvantage which isthat they cannot be secured to the cranium tightly enough to preventmovement of the supporting devices.

The apparatus of this invention overcomes the disadvantages of theaforementioned plaster skull cap and appliances, for this apparatus isadapted to counteract any force necessary to advance the fracturedfacial bones anteriorally, superiorally or laterally as the individualsituation warrants. Therefore, an object of this invention is to providean external cranial fixation apparatus which is adapted to be securelyanchored on the cranium for supporting fractured facial bones asrequired by each individual situation.

Another object of the present invention is to provide an externalcranial fixation apparatus which is easy to apply to the patient andwhich requires a minimum of maintenance.

A still further object of this invention is to provide a cranialfixation apparatus which may be anchored to the skull with greaterrigidity and which is light in weight and comfortable to the patient.

Yet another object of this invention is to provide a cranial fixationapparatus with an adjustable visor which is adapted to receive atraction anchor when connected by suitable means to maxillofacial bones.

Still another object of the present invention is to provide a cranialfixation apparatus with a traction anchor which is adapted to beconnected to a broken maxillofacial bone and to exert a force on thesame either in an upward, outward or downward direction.

Other objects and advantages of this invention will become apparent whenthe following detailed description is read in conjunction with theappended drawings, specification and claims. A preferred embodiment ofthis invention will now be described with reference to the accompanyingdrawings, in which:

FIGURE 1 is a perspective view of the external cranial fixationapparatus shown in position on a patients skull and supporting selectedfacial bones;

FIGURE 2 is a frontal, pictorial view of the invention showing the visorpivotally mounted on the halo structure;

FIGURE 3 is a fragmentary sectional view taken along lines 3-3 of FIGURE2 showing a traction anchor connected to the visor;

FIGURE 4 is a sectional view of the invention taken along lines 44 ofFIGURE 2 showing the visor adjusting mechanism; and

FIGURE 5 is a side view of one of the mounting pins.

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One embodiment of this invention is comprised of a light weight aluminumbar of square cross section and contoured to resemble an elliptical halowhich threadably receives a plurality of inwardly extending pins. Thepins are selectively spaced around the halo structure and have sharpconical inwardly extending ends which adapt the pins to be screwed intothe cranium of the patient and thus secure the elliptical halo structureabout the head. The posterior section of the elliptical halo structuretaken in relationship to the face of the user is bent downwardly so thatthe pins residing in that bent portion contact the cranium in the loweroccipital portions thereof so as to counteract any downward force on theanterior portions of the halo structure. The anterior frontal pin isused for proper stabilization and balance of the apparatus during useand the lateral cranial pins engage the cranium at a point distal to thethinnest portions of the cranium.

A visor which is also formed from an aluminum bar of square crosssection and which is semicircular in shape is pivotally mounted on theelliptical halo structure and extends anteriorally therefrom. The visoris adjustably connected to the anterial portions of the halo structureby means of a visor support and can be raised or lowered in accordancewith the individual fixation problem. The visor is adapted to receive aplurality of adjustably mounted traction anchors, selected ones of whichextend downwardly so that when it is attached to the facial bones bymeans of a wire and turn buckle arrangement, an outward force fromalmost any angle may be exerted on that selected facial bone.

The invention is illustrated in connection with the accompanyingdrawings in which the figures are illustrative of the preferredembodiment of the invention.

An elliptical halo structure It is formed from square section aluminumbar and is provided with a plurality of radially extending threadedholes 11 which are adapted to receive threaded pins such as indicated at8, 9, 12, 13, 14, 15, 16 and 17. Each pin is provided with a sharpconical point 18 at its inwardly extending end which is adapted topierce the skin and engage the skull with selected penetration into thebone. Each pin is also provided with an outwardly extending slotted end19 which adapts it to be screwed inwardly and outwardly throughelliptical halo structure 10-. As can be seen in FIGURE 4, the rearportions of elliptical halo structure 10 are bent downwardly so thatpins 12, 13 and 14 are placed in the posterior skull area in theundercut thereof. This bent structure allows pin 16 which is in theforward or anterior portions of halo structure 10 and which extends intothe superior regions of the cranium to counteract the rearward pullexerted by pins 12, 13 and 14 in the posterior position and therebycounteract the pressure applied thereto. Furthermore, this bentstructure at the rear of the halo allows the front of the halo to resideon the head of the user at a minimum elevation. Pins 17 and 15, whichare laterally positioned to extend into the sides of the cranium, arealso adapted to pivotally receive the ends of U-shaped visor 20.

Visor 20 which is formed of aluminum bar substantially square in crosssection is adjustably supported below the anterior port-ions of halostructure 10 by means of a visor support 23. Visor support 23 includesan L-shaped base 24 which is connected to a protrusion 21 which is anintegral extension of halo structure 10. Visor support 23 is rigidlymounted on protrusion 21 by means of screws 25 or the like and has anintegral and downwardly extending slotted arm 26 which is slidablyreceived by vertical bore 28 of post 29. Post 29 is provided with agrooved extension 30 which is mounted on visor 20 and is rigidly heldthereon by set screws 31. Post 29 is also provided with a laterallyextending threadably mounted locking screw 32 which extends through andis threadably received by threaded opening 33. Locking screw 32 isadapted to be screwed inwardly and engage a selected slot of slotted arm26 and thereby adjustably positions visor 20 relative to elliptical halostructure so that the necessary alignment can be carried out dependingon the individual fixation problem.

Visor is provided with a plurality of adjustably mounted tractionanchors which are given the reference numerals 37, 38, 3*) and 40. Eachof the traction anchors may be moved laterally and positioned so as toadapt the device to meet almost any individual circumstance. Each ofsaid traction anchors is adjustably positioned on visor 20 by means ofthe clamp bolt structure best shown in FIGURE 3. The visor receiving end42 of each traction anchor is provided with a groove 48 which laterallyextends therethrough and which substantially encloses a length of visor20. To secure visor 2G in visor receiving end 42, a threaded clamp bolt44 is adapted to be received by a threaded passageway 46 which ispositioned in visor receiving end 42 substantially adjacent groove 43.Clamp bolt 44 is provided with a flange 48 which upon the inward turningthereof pinches against visor 20 and frictionally holds the respectivetraction anchor in place thereon.

Each of said traction anchors as shown in FIGURE 1 is of a differentdesign and serves a different purpose and each may be shifted inaccordance with the needs of the individual patient. Traction anchor 37,for example, is provided with a short post portion 50 which has athreaded passageway in the end thereof which receives an eye bolt 51. Aturnbuckle 52 is swingably connected to eye bolt 51 and in theapplication illustrated in FIG- URE 1 has a wire 53 extending therefromwhich is connected to a facial bone 54. When turnbuckle 52 is tightened,the pull on facial bone 54 is upwardly due to the short length of postportion 50. Traction anchor 38 is L-shaped in design having legs 55 and56 with leg 56 extending substantially perpendicularly downwardly fromleg 55. Leg 56 is provided with a plurality of spaced and inwardlypointing threaded passageways 57 each of which is adapted to receive aneye bolt 58. Eye bolt 58, more than one of which may be received by leg56, receives turnbuckle 59 which is connected to and adapted to tightenwire 60 which is also connected to a facial bone 61. Facial bone 61 ispulled upwardly and outwardly by wire 60. Traction anchor 39 is providedwith legs 65 and an elongated leg 65 which perpendicularly extendsdownwardly from leg 65 and which is provided with a plurality ofinwardly pointing threaded holes 67. Eye bolts and 71 are threadablyreceived by selected holes 67 and are respectively provided withturnbuckles 72 and 73. Turnbuckles 72 and 73 are respectively connectedto facial bones 61 by means of wires 74 and 75. From FIGURE 1, it can beseen that wire 74, when tightened by turnbuckle 72, will pull facialbone 61 outwardly and wire 75, when tightened by turnbuckle 73, pullsfacial bone 61 outwardly and downwardly. Traction anchor 40 which ismounted directly in the center of visor 2t] and positioned thereon belowpost 29 is provided with a hole 78 which adapts arm 2a to extendtherethrough and with a threaded bore 79 which is adapted to receive aneye bolt (not shown).

In applying this appliance to the cranium of a patient, halo structure10 is positioned so that pins 12, 13 and 14 may be embedded in the skullin the posterior area and in the undercut thereof and pin 16 is embeddedin the anterior portions of the skull to insure proper stabilization ofthe appliance during use. Lateral pins 15 and 17 which are embedded onthe lateral sides of the skull insure a proper balance. The anglebetween the anterior portions of halo 10 and visor 2G is obtained bymoving visor 20 relative to halo structure 10 and tightening lockingscrew 32 against leg 26. Subsequently, a number of traction anchors suchas those represented by numerals 3'7, 38 and 39 are adjustablypositioned on visor 20 by manipulting their respective clamp bolts.Traction anchors 37, 38 and 39 are then connected to the facial bones tobe set by the turnbuckle and wire arrangement as shown in FIGURE 1.

From the description it can be seen that the structure described isadapted to pull the selected facial bone upwardly, upwardly andoutwardly, outwardly and downwardly, and downwardly, as well as toeither side in any of the mentioned vertical directions. By the propermounting of the pins, the visor and the traction anchors, considerablelatitude is obtained in setting the broken bone for knitting. Since thebones are rigidly held in place by this appliance, inadvertent movementof the bones is substantially reduced and therefore the knitting time isgreatly minimized. Furthermore, the bent arrangement of the halostructure insures a firm and positive grip of the undercut of the skullin the posterior area and allows the front elevation of the halo toremain relatively low.

Many different embodiments of this invention may be made withoutdeparting from the scope and spirit thereof. Therefore, it is to beunderstood that the invention is not to be limited to the specificembodiment shown and described herein, except as defined in the appendedclaims.

What is claimed is:

1. An external cranial fixation apparatus for aiding in the setting ofbroken maxillocranial bones for knitting comprising:

(a) a substantially elliptical rigid bar structure adapted forcircumscribing the cranium, said bar structure having a plurality ofradially extending, inwardly pointing pins for engaging said cranium andfor fixedly spacing said elliptical bar structure about said cranium;

(b) a U-shaped bar structure having its ends pivotally mounted onopposed portions of the periphery of said elliptical bar structure;

(c) means connected to and extending between said elliptical barstructure and said U-shaped bar structure for locking said U-shapedstructure relative said elliptical bar structure at a selected angle;

(d) traction element means adjustably and rigidly connected to saidU-shaped bar structure; and

(e) means connected to and extending from said traction element meansand adapted to be attached to said broken bone whereby said broken boneis restored to and maintained in its usual anatomical relationship forknitting.

2. The apparatus of claim 1 wherein said means connected to andextending between said U-shaped bar struc ture and said elliptical barstructure is a bar support rigidly mounted on said elliptical barstructure and having an integral and downwardly extending slotted armand a locking means securely mounted on said U-shaped bar structure andslidably receiving said slotted arm, said locking means adapted torigidly clasp said slotted arm at a selected point along the lengththereof.

3. The apparatus of claim 2 wherein said traction element means includesa plurality of traction elements, selected ones of which havingdownwardly extending arms, said arms having at least one means extendingtherefrom and adapted to be attached to said broken bone whereby saidbone may selectively be pulled upwardly, outwardly and downwardly torestore the same to its usual anatomical relationship for knitting.

4. The apparatus of claim 3 wherein said means extending from saidtraction element to said broken bone is comprised of an eye boltsecurely mounted on said traction element, a turnbuckle pivotallyconnected to said eye bolt and a wire connected to and extending fromsaid turnbuckle and adapted to be attached to said broken bone.

5. The apparatus of claim 4 wherein said elliptical bar structure has adownwardly bent portion along the lengths adjacent the posterior skullarea whereby said pins extending through said bent portion are adaptedto engage the undercut of the cranium.

6. The apparatus of claim 1 wherein said traction element means includesa plurality of traction elements, selected ones of which havingdownwardly extending arms, said arms having at least one means extendingtherefrom and adapted to be attached to said broken bone whereby saidhome may selectively be pulled upwardly, outwardly and downwardly torestore the same to its usual anatomical relationship for knitting.

7, The apparatus of claim 1 wherein said elliptical bar structure has adownwardly bent portion along the lengths adjacent the posterior skullarea whereby said pins extending through said bent portion are adaptedto engage the undercut of the cranium.

8. An external cranial fixation apparatus for aiding in the setting ofbroken maxillocranial bones for knitting comprising:

(a) a substantially elliptical rigid bar structure adapted to be spacedfrom and circumscribe said cranium, said elliptical bar structure havingdownwardly bent portions opposite the posterior of said cranium andhaving a plurality of radially extending threaded holes;

(b) a plurality of elongated threaded pins being threadably received byselected threaded holes and having pointed conical shaped inwardlypositioned ends for engaging said cranium whereby said elliptical barstructure is fixedly spaced about said cranium by said pins;

(c) a U-shaped bar structure having its ends pivotally mounted onopposed outer portions of the periphery of said elliptical bar structurein the area adjacent the lateral portions of said cranium, said U-shapedbar structure adapted to extend around the anterior portions of saidcranium;

(d) a bar support rigidly mounted on said elliptical bar structure andhaving an integral. and downwardly extending slotted arm;

(e) a locking means rigidly mounted on said U-shaped bar structure andslidably receiving said slotted arm, said locking means adapted torigidly clasp said slotted arm at a selected point along the lengththereof to fixedly position said U-shaped bar structure relative saidelliptical bar structure;

(f) a plurality of traction elements adjustably and rigidly connected tosaid U-shaped bar structure along the length thereof, selected ones ofsaid traction elements having downwardly extending arms of selectedlengths; and

(g) means connected to and extending from said traction element andadapted to be attached to said broken bones whereby said bones mayselectively be pulled upwardly, outwardly and downwardly to restore thesame to their usual anatomical relationship for knitting.

References Cited UNITED STATES PATENTS 1,398,842 1l/1921 Cruse12;8--89.1 2,151,458 3/1939 Allen 128-87 2,371,197 3/1945 Taylor 128-873,072,118 1/1963 Standerwick et al. 128--87 OTHER REFERENCES SkeletalTraction for Facial Fractures by Eben Alexander et al., Surgery,Gynecology and Obstetrics, vol. 119, No. 6, December 1964, pp.1326-1327.

RICHARD A. GAUDET, Primary Examiner. R. L. FRINKS, Examiner.

1. AN EXTERNAL CRANIAL FIXATION APPARATUS FOR AIDING IN THE SETTING OF BROKEN MAXILLOCRANIAL BONES FOR KNITTING COMPRISING: (A) A SUBSTANTIALLY ELLIPTICAL RIGID BAR STRUCTURE ADAPTED FOR CIRCUMSCRIBING THE CRANIUM, SAID BAR STRUCTURE HAVING A PLURALITY OF RADIALLY EXTENDING, INWARDLY POINTING PINS FOR ENGAGING SAID CRANIUM AND FOR FIXEDLY SPACING AND ELLIPTICAL BAR STRUCTURE ABOUT SAID CRANIUM; (B) A U-SHAPED BAR STRUCTURE HAVING ITS ENDS PIVOTALLY MOUNTED ON OPPOSED PORTIONS OF THE PERIPHERY OF SAID ELLIPITICAL BAR STRUCTURE; (C) MEANS CONNECTED TO AND EXTENDING BETWEEN SAID ELLIPTICAL BAR STRUCTURE AND SAID U-SHAPED BAR STRUCTURE FOR LOCKING SAID U-SHAPED STRUCTURE RELATIVE SAID ELLIPTICAL BAR STRUCTURE AT A SELECTED ANGLE; 